Health Care Needs and Costs for Children Exposed to Prenatal Substance Use to Adulthood-Reference-Cited by-同舟云学术

Health Care Needs and Costs for Children Exposed to Prenatal Substance Use to Adulthood

Published:2024-09-01 Issue:9 Volume:178 Page:888
ISSN:2168-6203
Container-title:JAMA Pediatrics
language:en
Short-container-title:JAMA Pediatr

Author:

Lee Evelyn¹²,Schofield Deborah²,Dronavalli Mithilesh³,Lawler Kate⁴,Uebel Hannah⁴⁵,Burns Lucinda⁶,Bajuk Barbara⁷,Page Andrew³,Gu Yuanyuan⁸,Eastwood John⁹¹⁰¹¹¹²¹³,Dickson Michelle¹⁴,Green Charles¹⁵,Dicair Lauren¹⁶,Oei Ju Lee⁴¹⁷¹⁸

Affiliation:

1. Centre for Social Research in Health, University of New South Wales, Kensington, New South Wales, Australia

2. Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia

3. Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia

4. Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Australia

5. Department of Paediatrics, Sydney Children’s Hospital, Sydney, New South Wales, Australia

6. National Drug and Alcohol Research Centre, University of New South Wales, Kensington, New South Wales, Australia

7. Critical Care Program, Sydney Children’s Hospitals Network, Sydney, New South Wales, Australia

8. Macquarie University Centre for the Health Economy, Macquarie Business School and Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia

9. National Public Health Service, Te Whatu Ora – Health New Zealand, Dunedin, New Zealand

10. School of Population Health, University of New South Wales, Kensington, New South Wales, Australia

11. Department of Preventative and Social Medicine, University of Otago, Dunedin, New Zealand

12. Sydney Institute for Women Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia

13. Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia

14. The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia

15. Alpha Maxx Healthcare, Memphis, Tennessee

16. Private Practice, Havertown, Pennsylvania

17. Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia

18. Drug and Alcohol Services, Murrumbidgee Local Health District, Wagga Wagga, New South Wales, Australia

Abstract

ImportanceChildren exposed to substance use during pregnancy have increased health needs but whether these are influenced by engagement in out-of-home care is uncertain.ObjectiveTo evaluate the association between substance use during pregnancy, out-of-home care and hospitalization utilization, and costs from birth up to age 20 years.Design, Setting, and ParticipantsThis was a retrospective cohort study using individual-linked population birth, hospital, and out-of-home care information of all liveborn infants from New South Wales, Australia, between 2001 and 2020 using longitudinal population-based linkage records from administrative databases. Substance use during pregnancy included newborns with neonatal abstinence syndrome (n = 5946) and intrauterine exposure to drugs of addiction (n = 1260) and other substances (eg, tobacco, alcohol, and illicit drugs or misused prescription drugs; n = 202 098). Children not exposed to substance use during pregnancy were those without known exposure to substance use during pregnancy (n = 1 611 351). Data were analyzed from July 2001 to December 2021.Main OutcomesMain outcomes were hospital readmission, length of stay, and cost burden associated with substance use during pregnancy from birth up to age 20 years. Outcomes were investigated using 2-part and Poisson regression models adjusted for sociodemographic characteristics. Mediation analysis was used to evaluate whether the association of substance use during pregnancy with risk of readmission was mediated through engagement with out-of-home care.ResultsOf the 1 820 655 live births, 935 807 (51.4%) were male. The mean (SD) age of mothers was 30.8 (5.5) years. Compared with children who were not exposed to substance use during pregnancy, those who were exposed incurred significantly higher birth hospital costs (adjusted mean difference, A$1585 per child [US$1 = A$1.51]; 95% CI, 1585-1586). If discharged alive, more children with exposure to substance use during pregnancy had at least 1 readmission (90 433/209 304 [43.4%] vs 616 425/1 611 351[38.3%]; adjusted relative risk [RR], 1.06; 95% CI, 1.06-1.07), most commonly for respiratory conditions (RR, 1.11; 95% CI, 1.09-1.12) and mental health/behavioral disorders (RR, 1.36; 95% CI, 1.33-1.41). Excess hospital costs associated with substance use during pregnancy were A$129.0 million in 2019 to 2020. Mediation analyses showed that any out-of-home care contact mediated the association between substance use during pregnancy and risk of inpatient readmission and lower health care cost (decreased by A$25.4 million). For children with neonatal abstinence syndrome, any out-of-home care contact mediated readmission risk by approximately 30%, from adjusted RR, 1.28; 95% CI, 1.19-1.35, to RR, 1.01; 95% CI, 0.98-1.02.Conclusion and RelevanceChildren who were exposed to substance use during pregnancy incurred more hospital costs than children who were not exposed up to 20 years of age, but this was reduced in association with any contact with out-of-home care. This provides insights into possible strategies for reducing health and financial burdens associated with exposure to substance use during pregnancy for children.

Publisher

American Medical Association (AMA)

Link

https://jamanetwork.com/journals/jamapediatrics/articlepdf/2821473/jamapediatrics_lee_2024_oi_240039_1724260044.72986.pdf

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